In total, 337 children living with HIV participated in our study. However, data from nine children were excluded owing to missing values. Finally, data from 328 children were included in the analysis. Regarding the interview responses, 100 were from the children only and 228 were from both children and caregivers.
General characteristics
Table 1 shows the characteristics of participant children. Of all the children, 48.2% were female. The mean age of the children was 10.8 years (SD 3.0). The mean duration of ART was 6.3 years (SD 3.6). Moreover, 68.3% of children had an undetectable viral load. Among children with a detectable viral load, the load ranged up to approximately 5 012 000 copies/mL. Of the participants, 93.0% had at least one permanent tooth (age range, 6–15 years old); 57.3% had at least one deciduous tooth (age range, 3–15 years old). Of them, 50.3% had both permanent and deciduous teeth (age range, 6–15 years old). The mean values for DMFT and dmft were 4.0 (SD 3.6) and 7.0 (SD 4.9), respectively. The mean number of teeth with caries including permanent and deciduous teeth was 7.7 (SD 5.0). Only 5.8% of children were free from caries. For adherence to antiretroviral drugs, no children answered “very poor”. The most frequent response was “good” (51.2%).
Table 1. General characteristics and health status of the study participants
Characteristic
|
All children
|
|
Children with detectable viral load
|
(n = 328)
|
|
(n = 104)
|
Sex, n (%)
|
|
|
|
|
|
|
female
|
158
|
(48.2)
|
|
46
|
(44.2)
|
|
male
|
170
|
(51.8)
|
|
58
|
(55.8)
|
Age (years), mean (SD)a
|
10.8
|
(3.0)
|
|
10.3
|
(3.3)
|
|
3–5
|
19
|
(5.8)
|
|
9
|
(8.7)
|
|
6–7
|
31
|
(9.5)
|
|
15
|
(14.4)
|
|
8–10
|
78
|
(23.8)
|
|
20
|
(19.2)
|
|
11–12
|
91
|
(27.7)
|
|
27
|
(26.0)
|
|
13–15
|
109
|
(33.2)
|
|
33
|
(31.7)
|
Duration of ARTb (years), mean (SD)
|
6.3
|
(3.6)
|
|
4.9
|
(3.7)
|
|
<1
|
28
|
(8.5)
|
|
19
|
(18.3)
|
|
≥1
|
300
|
(91.5)
|
|
85
|
(81.7)
|
Viral load, n (%)
|
|
|
|
|
|
|
undetected
|
224
|
(68.3)
|
|
–
|
–
|
|
detected (>40 copies/mL)
|
104
|
(31.7)
|
|
–
|
–
|
Viral load detected (n = 104) (copies/mL), n (%)
|
|
<40
|
–
|
–
|
|
26
|
(25.0)
|
|
40–100
|
–
|
–
|
|
16
|
(15.4)
|
|
100–1000
|
–
|
–
|
|
12
|
(11.5)
|
|
1000–10 000
|
–
|
–
|
|
12
|
(11.5)
|
|
10 000–100 000
|
–
|
–
|
|
28
|
(26.9)
|
|
>100 000
|
–
|
–
|
|
10
|
(9.6)
|
Children without dental caries, n (%)
|
19
|
(5.8)
|
|
5
|
(4.8)
|
Dental caries status, n (%)
|
|
|
|
|
|
|
DMFTc (total children, n = 305) (children with detectable viral load, n = 93)
|
4.0
|
(3.6)
|
|
4.2
|
(4.1)
|
|
dmftd (total children, n = 188) (children with detectable viral load, n = 68)
|
7.0
|
(4.9)
|
|
7.8
|
(5.0)
|
|
DMFT/dmft (total children, n = 328) (children with detectable viral load, n = 104)
|
7.7
|
(5.0)
|
|
8.9
|
(5.3)
|
Adherence to antiretroviral drugs in the past 30 days, n (%)
|
|
very poor
|
0
|
(0.0)
|
|
0
|
(0.0)
|
|
poor
|
3
|
(0.9)
|
|
3
|
(2.9)
|
|
fair
|
25
|
(7.6)
|
|
9
|
(8.7)
|
|
good
|
168
|
(51.2)
|
|
54
|
(51.9)
|
|
very good
|
75
|
(22.9)
|
|
28
|
(26.9)
|
|
excellent
|
52
|
(15.9)
|
|
8
|
(7.7)
|
|
unknown
|
5
|
(1.5)
|
|
2
|
(2.0)
|
aSD, standard deviation
bART, antiretroviral therapy
cDMFT, decayed, missing, or filled permanent teeth
ddmft, decayed, missing, or filled deciduous teeth
Association between dental caries and detectable viral load
Table 2 shows the bivariate and multivariate associations between different factors and detectable viral load. The bivariate analyses indicated that total DMFT/dmft was positively associated with detectable viral load (odds ratio [OR]: 1.07, 95% CI: 1.02–1.12). Being on ART for ≥1 year (OR: 0.19, 95% CI: 0.08–0.43) and “excellent” adherence to antiretroviral drugs (OR: 0.24, 95% CI: 0.08–0.70) were significantly associated with an undetectable viral load.
Table 2. Association between dental caries and viral detection (>40 copies/mL)
Variable
|
|
|
Bivariate analysis with viral detectiona
|
|
Multivariate analysis with viral detection among children who had permanent teeth (n = 305)
|
|
Multivariate analysis with viral detection among children who had deciduous teeth (n = 188)
|
|
Multivariate analysis with viral detection among all children (n = 328)
|
|
|
|
Crude ORb
|
95% CIc
|
|
Adjusted OR
|
95% CI
|
|
Adjusted OR
|
95% CI
|
|
Adjusted OR
|
95% CI
|
|
Dental caries status
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
DMFTd
|
|
|
1.02
|
0.96
|
1.10
|
|
1.02
|
0.94
|
1.10
|
|
–
|
–
|
–
|
|
–
|
–
|
–
|
|
|
dmfte
|
|
|
1.06
|
0.99
|
1.12
|
|
–
|
–
|
–
|
|
1.10
|
1.01
|
1.19
|
*
|
–
|
–
|
–
|
|
|
DMFT/dmft
|
|
|
1.07
|
1.02
|
1.12
|
**
|
–
|
–
|
–
|
|
–
|
–
|
–
|
|
1.07
|
1.01
|
1.14
|
*
|
Sex
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
female
|
|
|
Ref.
|
–
|
–
|
|
Ref.
|
–
|
–
|
|
Ref.
|
–
|
–
|
|
Ref.
|
–
|
–
|
|
|
male
|
|
|
1.26
|
0.79
|
2.01
|
|
1.35
|
0.80
|
2.37
|
|
1.67
|
0.86
|
3.24
|
|
1.39
|
0.84
|
2.29
|
|
Age (years)f
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3–10
|
|
|
Ref.
|
–
|
–
|
|
Ref.
|
–
|
–
|
|
Ref.
|
–
|
–
|
|
Ref.
|
–
|
–
|
|
|
11–15
|
|
|
0.80
|
0.50
|
1.29
|
|
0.91
|
0.49
|
1.66
|
|
2.11
|
0.94
|
4.77
|
|
1.03
|
0.59
|
1.82
|
|
Duration of ARTg (years)h
|
|
<1
|
|
|
Ref.
|
–
|
–
|
|
Ref.
|
–
|
–
|
|
Ref.
|
–
|
–
|
|
Ref.
|
–
|
–
|
|
|
≥1
|
|
|
0.19
|
0.08
|
0.43
|
**
|
0.18
|
0.07
|
0.45
|
**
|
0.19
|
0.07
|
0.57
|
**
|
0.22
|
0.09
|
0.52
|
*
|
Adherence to antiretroviral drugs in the past 30 days
|
|
poor/fair
|
|
|
Ref.
|
–
|
–
|
|
Ref.
|
–
|
–
|
|
Ref.
|
–
|
–
|
|
Ref.
|
–
|
–
|
|
|
good
|
|
|
0.63
|
0.28
|
1.43
|
|
0.51
|
0.22
|
1.18
|
|
0.79
|
0.21
|
3.02
|
|
0.56
|
0.24
|
1.31
|
|
|
very good
|
|
|
0.79
|
0.33
|
1.92
|
|
0.64
|
0.26
|
1.61
|
|
0.83
|
0.20
|
3.43
|
|
0.63
|
0.25
|
1.58
|
|
|
excellent
|
|
|
0.24
|
0.08
|
0.70
|
*
|
0.21
|
0.07
|
0.65
|
**
|
0.21
|
0.04
|
0.97
|
*
|
0.16
|
0.05
|
0.51
|
**
|
*p < 0.05, **p < 0.01
aViral load was a binary variable (detected or undetected)
bOR, odds ratio
cCI, confidence interval
dDMFT, decayed, missing, or filled permanent teeth
edmft, decayed, missing, or filled deciduous teeth
fThe cut-off was set as 10 years old (median of mixed dentition)
gART, antiretroviral therapy
hThe cut-off was set as 1-year (most likely period attaining viral RNA thresholds in low- and middle-income countries [35])
Multiple logistic regression analyses were performed in three models stratified by the presence of certain teeth: only permanent teeth, only deciduous teeth, and any teeth. The model that included children with permanent teeth (n = 305) showed that ≥1 year on ART (adjusted OR [AOR]: 0.18, 95% CI: 0.07–0.45) and “excellent” adherence to antiretroviral drugs (AOR: 0.21, 95% CI: 0.07–0.65) were negatively associated with detectable viral load. The model that included children with deciduous teeth (n = 188) showed that dmft was positively associated with detectable viral load (AOR: 1.10, 95% CI: 1.01–1.19). At least 1 year on ART (AOR: 0.19, 95% CI: 0.07–0.57) and “excellent” adherence to antiretroviral drugs (AOR: 0.21, 95% CI: 0.04–0.97) were negatively associated with detectable viral load. The model that included children with all types of teeth (n = 328) showed that total DMFT/dmft was positively associated with detectable viral load (AOR: 1.07, 95% CI: 1.01–1.14), and that ≥1 year on ART (AOR: 0.22, 95% CI: 0.09–0.52) and “excellent” adherence to antiretroviral drugs (AOR: 0.16, 95% CI: 0.05–0.51) were negatively associated with detectable viral load.
Association between dental caries and viral non-suppression
Table 3 shows the association between dental caries and viral non-suppression (>1000 copies/mL). The bivariate analyses showed that dmft (OR: 1.12, 95% CI: 1.01–1.25) and total of DMFT/dmft (OR: 1.10, 95% CI: 1.02–1.19) were positively associated with viral non-suppression.
Table 3. Association between dental caries and viral non-suppression (>1000 copies/mL)
Variable
|
|
Bivariate analysis with viral non-suppressiona
|
|
Multivariate analysis with viral non-suppression status among children who had permanent teeth (n = 93)
|
|
Multivariate analysis with viral non-suppression among children who had deciduous teeth (n = 68)
|
|
Multivariate analysis with viral non-suppression among all children whose viral load was detected (n = 104)
|
|
|
Crude ORb
|
95% CIc
|
|
Adjusted OR
|
95% CI
|
|
Adjusted OR
|
95% CI
|
|
Adjusted OR
|
95% CI
|
|
|
Dental caries status
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
DMFTd
|
|
0.99
|
0.90
|
1.10
|
|
1.00
|
0.90
|
1.12
|
|
–
|
–
|
–
|
|
–
|
–
|
–
|
|
|
dmfte
|
|
1.12
|
1.01
|
1.25
|
*
|
–
|
–
|
–
|
|
1.22
|
1.05
|
1.41
|
*
|
–
|
–
|
–
|
|
|
DMFT/dmft
|
|
1.10
|
1.02
|
1.19
|
*
|
–
|
–
|
–
|
|
–
|
–
|
–
|
|
1.12
|
1.03
|
1.23
|
*
|
Sex
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
female
|
|
Ref.
|
–
|
–
|
|
Ref.
|
–
|
–
|
|
Ref.
|
–
|
–
|
|
Ref.
|
–
|
–
|
|
male
|
|
1.92
|
0.87
|
4.20
|
|
1.50
|
0.63
|
3.55
|
|
1.22
|
0.39
|
3.81
|
|
1.87
|
0.81
|
4.34
|
|
Age (years)f
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3–10
|
|
Ref.
|
–
|
–
|
|
Ref.
|
–
|
–
|
|
Ref.
|
–
|
–
|
|
Ref.
|
–
|
–
|
|
|
11–15
|
|
0.88
|
0.40
|
1.91
|
|
1.00
|
0.38
|
2.65
|
|
3.88
|
0.97
|
15.4
|
|
1.49
|
0.59
|
3.78
|
|
Duration of ARTg (years)h
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
<1
|
|
Ref.
|
–
|
–
|
|
Ref.
|
–
|
–
|
|
Ref.
|
–
|
–
|
|
Ref.
|
–
|
–
|
|
|
≥1
|
|
0.80
|
0.30
|
2.17
|
|
0.67
|
0.22
|
2.10
|
|
0.71
|
0.18
|
2.71
|
|
0.83
|
0.28
|
2.52
|
|
Adherence to antiretroviral drugs in the past 30 days
|
|
|
|
|
|
|
|
poor/fair
|
|
Ref.
|
–
|
–
|
|
Ref.
|
–
|
–
|
|
Ref.
|
–
|
–
|
|
Ref.
|
–
|
–
|
|
|
good
|
|
0.86
|
0.25
|
3.01
|
|
0.83
|
0.23
|
2.97
|
|
0.69
|
0.08
|
6.25
|
|
0.75
|
0.20
|
2.86
|
|
|
very good
|
|
1.00
|
0.26
|
3.87
|
|
0.75
|
0.18
|
3.12
|
|
1.76
|
0.17
|
18.8
|
|
0.92
|
0.22
|
3.96
|
|
|
excellent
|
|
1.00
|
0.17
|
5.99
|
|
1.14
|
0.16
|
8.17
|
|
0.47
|
0.03
|
6.84
|
|
0.68
|
0.10
|
4.91
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
*p < 0.05, **p < 0.01
aViral load was a binary variable with a cut-off of log3.00 (=1000 copies/mL)
bOR, odds ratio
cCI, confidence interval
dDMFT, decayed, missing, or filled permanent teeth
edmft, decayed, missing, or filled deciduous teeth
fThe cut-off was set as 10 years old (median of mixed dentition)
gART, antiretroviral therapy
hThe cut-off was set as 1-year (most likely period attaining viral RNA thresholds in low- and middle-income countries [35]
Among children with detectable viral load and who had deciduous teeth (n = 68), dmft was positively associated with viral non-suppression (AOR: 1.22, 95% CI: 1.05–1.41). Among all children with detectable viral load (n = 104), the analyses indicated that total DMFT/dmft was positively associated with viral non-suppression (AOR: 1.12, 95% CI: 1.03–1.23).